Allergy Watch: SLUCare Allergy & Immunology

Identifying and Treating Allergies

Spring looks good on paper, but for people with allergies, it's not all it's cracked
up to be. And neither is summer. A warm breeze means pollen, flowers mean bees. For
the allergic, life outdoors can mean ‘miserable.' Seasonal allergic rhinitis (or hay fever) affects millions of people worldwide and causes sneezing, runny or
itchy nose, itchy eyes, mouth or ears, and general stuffiness. These allergic reactions,
says SLUCare allergist and immunologist Dr. Mark Dykewicz, are most commonly caused by pollen and mold spores in the air and occur at different
times depending on geographic location. In the Midwest, for example, tree pollen is
most prolific in early to late spring, grasses in late spring, ragweed in late summer
and mold throughout the growing season. Year-round allergic problems can be caused
by things like dust, dust mite droppings and pet dander.

However, according to Dykewicz, rhinitis isn't always caused by an allergic response.
"Sometimes, it's simply a cold, sometimes it's a reaction to other environmental irritants
like perfumes, cleaning products and sudden temperature changes. And sometimes, it
has no relation to environmental exposures at all," he says. Testing of the skin or
blood can help determine whether an allergy is present, in which case antihistamines
and nasal steroids (both prescription and over-the-counter) are effective treatments.
He notes that the FDA recently approved a sublingual (under-the-tongue) tablet for
grass and ragweed allergies, but the course must be started three months in advance
of the pollens' appearance. Dykewicz adds that no amount of antihistamine will help
with nonallergic symptoms. "You'll be wasting your money!" he says.

Like rhinitis, asthma either may be allergic or non-allergic. Both forms involve an inflammation of the
airways, which become swollen and constricted, making it difficult for air to move
in and out of the lungs. While both allergic and non-allergic asthma can be triggered
by exercise, allergic asthma (the most common form) is caused by inhaling allergens
like pollen, mold and dust. According to Dykewicz, asthma caused by a cockroach allergy
is the cause of many emergency room visits. He says people who suffer from exercise-induced
asthma should not cut back on physical activity, but rather work with a physician
to develop a safe management plan. Inhalers containing anti-inflammatory medication
are helpful, he notes.

Food allergy reactions can be life-threatening, so people must be very careful to
avoid their food triggers and carry auto-injectable epinephrine.”

In terms of food, Dykewicz says the line between allergy and intolerance becomes blurred,
but the differences between the two are very important. "If you are allergic to a
food, this allergen triggers a response in the immune system," he explains. "Food allergy reactions can be life-threatening, so people must be very careful to avoid their
food triggers and carry auto-injectable epinephrine." Although many food allergies
are diagnosed in young children, sometimes a reaction "comes out of nowhere" in adulthood.
"If you don't even know you have an allergy, you can't take precautions," Dykewicz
says. An allergic reaction can occur within minutes and might involve cramping and
vomiting, throat constriction, difficulty breathing, body swelling and hives.

Dykewicz says the prevalence of peanut allergy has increased significantly over the
past several decades in many countries, but a new theory may offer hope. "We used
to say allergic children should avoid the allergen, but recent evidence might show
that a little bit of early exposure to peanuts may prevent the development of a peanut
allergy. It's a sea-change in thinking," Dykewicz says.

According to the American Academy of Allergy, Asthma and Immunology, eight foods are
responsible for the majority of allergic reactions: cow's milk, eggs, fish, peanuts,
shellfish, soy, tree nuts and wheat.

If you've have had a reaction in the past, it might be wise to be evaluated by an
allergist because auto-injectable epinephrine might not be enough to prevent fatality.”

Insect stings also can cause severe allergic responses, and Dykewicz says there needs to be more
awareness of the importance of venom desensitization shots. "If you've have had a
reaction in the past, it might be wise to be evaluated by an allergist because auto-injectable
epinephrine might not be enough to prevent fatality," he stresses.